Risk factors and prognosis of late acute rejection in Chinese kidney transplant recipients

ABSTRACT Aim Accumulating literature indicates that late acute rejection (LAR) after kidney transplantation portends an unfavourable prognosis. There are no data on the incidence of LAR in Asian subjects, or its risk factors and associated clinical outcomes. Methods We conducted a retrospective sing...

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Bibliographic Details
Published in:Nephrology (Carlton, Vic.) Vic.), 2017-12, Vol.22 (12), p.985-992
Main Authors: Mok, Maggie Ming Yee, Ma, Maggie Kam Man, Yap, Desmond Yat Hin, Chan, Gavin Sheung Wai, Lam, Man Fai, Kwok, Janette Siu Yin, Kwan, Lorraine Pui Yuen, Chan, Gary Chi Wang, Choy, Cindy Bo Ying, Tang, Sydney Chi Wai, Chan, Tak Mao
Format: Article
Language:English
Subjects:
Acute Disease
Adult
allograft
Cyclosporin A
Female
Graft rejection
Graft Rejection - etiology
Graft Survival
Humans
Immunosuppression
immunosuppressive agents
Kidney transplantation
Kidney Transplantation - adverse effects
Kidney Transplantation - mortality
Liver
Logistic Models
Male
Medical prognosis
Middle Aged
Mycophenolic acid
Patients
Prognosis
Risk Factors
Survival
Transplantation
Transplants & implants
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Summary:ABSTRACT Aim Accumulating literature indicates that late acute rejection (LAR) after kidney transplantation portends an unfavourable prognosis. There are no data on the incidence of LAR in Asian subjects, or its risk factors and associated clinical outcomes. Methods We conducted a retrospective single‐centre case‐+control study to investigate the incidence, risk factors and prognosis of LAR in Chinese kidney transplant recipients. Subjects with or without LAR were matched for age, gender, era of transplantation, allograft type, and maintenance immunosuppression regimen. Results Thirty‐two episodes of LAR occurred within an observation period of 12 years giving an incidence rate of 0.46 episodes per 1000 patient‐years. Acute rejection within the first year after transplantation was associated with an increased risk of LAR (OR 3.59, P = 0.041). In patients receiving maintenance immunosuppression regimen with steroid, cyclosporin A (CsA) and mycophenolate or an m‐TOR inhibitor, patients with LAR showed lower trough CsA levels prior to and at the time of rejection compared to Controls (86.0 ± 26.1 vs. 105.6 ± 13.3 μg/L, P = 0.049; and 75.7 ± 35.7 vs. 106.0 ± 20.5 μg/L, P = 0.032, respectively). Trough CsA level below 80 μg/L was associated with the development of LAR (OR 10.82, P = 0.032). Patients with LAR showed an inferior allograft survival (P 
ISSN:1320-5358
1440-1797
DOI:10.1111/nep.12917